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Flashcards in Reading material Deck (119):
1

What is the order in which the blood tubes should be filled?

1. Blood culture
2. Tube withOUT additives (red tubes)
3. Tubes WITH additives

2

What are red tubes used for?

Chemistries, amylase, Igs

3

What are blue tops used for?

PT
PTT
INR

4

What are green tops used for?

Ammonia
CPK isozymes

5

What are purple top tubes used for?

CBC
ABO types

6

What are gray top tubes used for?

Ethanol

7

What are pink top tubes used for?

Cross matching

8

Which colored tube does not have any additives?

Red

9

True or false: you should not draw blood on the side of the body that a mastectomy was performed

True

10

True or false: when drawing blood on the side of an arm with an IV in place, you should draw above the IV site

False-- I don't know why though

11

What should you never do after cleaning a venipuncture site?

touch it

12

True or false: you should gently invert or shake the tubes of blood in a blood draw

False-- NEVER shake. But the inverting bit is a good idea

13

What are the landmarks that should be palpated before doing a cricoidotomy?

Thyroid and cricoid cartilage (between them in the cricothyroid ligament)

14

What direction should the needle face when performing a needle cricoidotomy? When should you stop advancing the needle?

45 degrees inferiorly

Stop when air is aspirated into the syringe

15

How long can adequate ventilation be achieved with a needle cricothyroidotomy?

30-45 minutes

16

What is the age cutoff (lower bound) for surgical cricothyroidotomy?

12 yo

17

Central line placement for the IJV is on what side of the body? Subclavian?

IJV = right side
Subclavian = left side

18

What are the landmarks used for placing a central line into the subclavian? How should the hands be placed? How should the needle be inserted?

Thumb on the sternal notch
Index finger on the intersection between the clavicle and the first rib. Insert needle lateral to the thumb, and beneath the clavicle.

19

What are the landmarks used for central line placement in the IJV?

Between the two heads of the SCM

20

What way should the tip of the J wire be inserted in an IJV central line?

Toward the heart

21

What must be monitored with a IJV central line placement? Why?

EKG for arrhythmias

22

What is the minimal amount of blood that can be seen on a CXR for a hemothorax?

300-500 ml

23

What should you do if draining more than 1500 ml of blood from a chest tube?

Get to OR for thoracotomy to control bleeding

24

What are the ribs that are used for landmarks for a chest tube placement with a pneumothorax? Where?

3 4 or 5 intercostal space along the anterior axillary line

25

Which intercostal spaces are used for chest tube placement with a hemothorax?

3 4 or 5 along the posterior or midaxillary line

26

What is the position the pt should be placed in for a chest tube placement?

arm over head

27

What is the area relative to the rib where you should place the chest tube?

On top of the lower rib in the intercostal space to prevent hitting the intercostal arteries/nerves that lie below the ribs

28

What is the tool used to make the puncture for a chest tube?

Hemostat (after making an incision with a scalpel)

29

Which way should a chest tube be inserted toward for a hemothorax? Pneumothorax?

Hemo = down
Pneumo = up

30

Widening of the mediastinum following a chest tube placement may indicate what?

Thoracic aorta dissection

31

What is tidaling with chest tube placement?

Movement of the ball in the pleurivac

32

True or false: except for checking for leaks, a chest tube should never be clamped off

True

33

What should be done with a pneumo and hemothorax concurrently?

Chtes tubes place anterior and posterolaterally

34

What indicated that a chest tube was successful?

No more tidaling

35

What is a laproscopic surgery?

Small tools + CO2 inflated peritoneum

36

What are the spaces that an LP should be performed at?

L4-L5

37

Which way should the needle be driven in a LP?

toward the naval

38

What is the only position in which you are able to get an opening pressure with a LP?

Lateral recumbent

39

Why should you never introduce negative pressure with a LP?

will cause hemorrhage

40

What are the first three tubes that are used in the collection of CSF (in order)?

1. cell count and differential
2. Gram stain cultures
3. Glucose, protein,

41

What happens if you get a bloody tap?

May have hit the venous plexus, which will stop after you draw more

42

Name the mallampati score: clear visualization of the faucial pillar, soft palate, and uvula

I

43

Name the mallampati score: The uvula is masked by the tongue, but o/w clear visualization of the facial pillars and soft palate

II

44

Name the mallampati score: Only the soft palate is visualized

III

45

Name the mallampati score: Only the hard palate is visualized

IV

46

Why should you not rock the laryngoscope?

Will break teeth

47

Is it every okay to let go of the ET tube?

No

48

Each time the patient is moved with a ETT in, what is the chance that it will dislodge?

10-15%

49

What is the Selleck manuver?

Applying pressure to the cricoid cartilage during an intubation

50

Should you try to intubate through a glottis that is closed d/t a laryngeal spasm?

Never

51

What are the four regions assessed during a FAST exam?

1. Pericardial (Pericardial effusion)
2. RUQ (spleen)
3. LUQ (kidneys)
4. Pelvic (pouch of douglas)

52

Hyperechoic appears what color on the screen? Hypoechoic?

Hyper = white
Hypo = black

53

What does red flow indicate? Blue?

Red = toward you
Blue = away from you

54

What is the size of the urinary catheter that should be used for adults? What if they have gross hematuria?

16-18 french
22-24 for patients with gross hematuria

55

What is the only absolute contraindication for urinary catheterization?

Trauma to the urethra (e.g. pelvic fracture)

56

When are triple lumen catheters used?

For patients with clots or obstruction

57

What way should the penis be held when doing a cath?

Perpendicular to the body

58

What should you do prior to inflating the foley cath balloon?

Check for urine return

59

Name two relative contraindications for urethral catheterization (3 are given)

Urethral stricture
Recent urethral/bladder surgery
Combative patient

60

Name two contraindications to performing an LP.

Cardiorespiratory compromise
Cerebral herniation
Focal neurological signs
Bleeding diathesis
Previous lumbar surgery

61

What gauge needle is usually used for an LP?

20-22

62

What should you do first if there is no flow from an LP?

Rotate the needle 90 degrees, since a nerve rootlet may be obstructing the flow

63

What should you do if there is blood in an LP needle?

get a new needle and enter a new interspace, since you do not want it to clog

64

Over what mmH2O is concerning in a spinal tap

20

65

Why should you never aspirate a LP?

May cause a herniation

66

What is the size of the triple lumen catheter that should be used for central lines? What about for fluid resuscitation?

7 french

11.5 if resuscitation

67

What are the contraindications to tracheal intubation?

Trauma
Burns
Tumor
Edema
Infection

68

What does gauge measure? What does a high gauge needle mean?

Measures the diameter of a needle.

Larger gauge means smaller needle size

69

What does bore size indicate?

size of the lumen (inside diameter)

70

What are the three layers of a vessel, and what is the important part of each?

Outer layer = tunica adventitia (supporting vasculature)
Middle layer = tunica media (muscular layer)
Inner layer = tunica intima (elastic layer)

71

How often should peripheral IV catheters be changed?

every 72 hours

72

When is it appropriate to give D5W to a patient IV?

Never-- will raise glucose levels too fast, and cause osmotic diuresis

73

What type of fluids do you want to use when replacing volume: hypotonic, isotonic, or hypertonic

isotonic

74

What are the electrolyte concentrations in NS? pH?

154 Na and Cl

pH is 4-5

75

What are the electrolyte concentrations in LR? pH?

130 Na
110 Cl
4 K
100 H2O

7ish pH

76

What are the electrolyte concentrations in D5W? D10W?

D5 = 50 gm glucose
D10 = 100 gm glucose

both have 1000 ml of water

77

What are the electrolyte concentrations in 3% NS?

513 Na
513 Cl

78

What is the rule for choosing an IV rate per hour?

4 ml/kg for first 10 kg
2 ml/kg for next 10 kg
1 ml/kg for each kg thereafter

79

What is the angle of the injection that should be done with SQ administration of a drug? IM?

SQ = 45 degrees
IM = 90 degrees

80

What are the sites of injection of IM meds?

Anterior/posterior forearms, tricep area, chest, or shoulder blade area

81

What is the preferred site of injection for heparin?

Lower abdominal fat pad, beneath the umbilicus

82

Under what age should the dorsogluteal muscle not be used?

3 years of age

83

When injecting into the gluteal area, how do you ensure that you are in the correct area?

Place hand so that the 2nd finger is on the ASIS, and spread your fingers. Inject between the space formed by digits 2 and 3.

84

What is meant by the "Z" track injection?

Pulling the skin back when injecting, thus creating a non-linear path for blood to flow out when the needle is removed and the skin released

85

What are the indications for an NG tube? Contraindications?

Acute gastric dilatation/distention
Gastric outlet obstruction
Ileus

Contraindications:
-recent esophageal surgery
-absence of gag reflex
-facial or nasal trauma

86

True or false: esophageal varices are a contraindication to placing an NG tube

False

87

What are the indications for a needle cricothyroidotomy?

Complete airway obstruction
Trauma to the face

88

What are the two complications of a needle or surgical cricothyroidotomy?

Asphyxia
Aspiration

89

What are the two contraindications to a surgical cricothyroidotomy?

Children under 12
There is a less radical means of establishing an airway

90

What are the indications for a central line placement?

TPN
Long term infusion of drugs

91

What are the contraindications for a central line placement?

Morbidly obese
Infection over insertion site
Pneumo/hemothorax on the ipsilateral side

92

What are the two pre-procedure bits prior to doing a central line placement?

Consent and timeout

93

What is the position the patient should be placed in for a central line placement?

Trendelenburg

94

What gauge needle should be used when performing a subclavian or IJV central line placement?

18

95

In what order should the scalpel, dilator, J wire, 18 gauge needle, and catheter be introduced in a central line placement?

Needle/catheter
J wire
scalpel
dilator
Central catheter

96

What should you do after placing a central line?

Check all ports for blood return

97

What size tube should be used for pneumothorax in a child/adult? Hemo?

Pneumo: 22ish or 11ish
Hemo: 22 ish or 15ish

98

True or false: when suturing, you should always select the smallest diameter suture that can adequately hold the tissue edges together.

true

99

What size of suture should be used for regular skin closures?

3-0, 4-0, or 5-0

100

What size of suture should be used for skin closure on the face?

5-0 or 6-0

101

What size of suture should be used on abdominal fascia closure?

#2 or 0

102

What are the two types of points to a suture needle?

taper point
Cutting point

103

What is a #10 blade used for? #11? #12? #15? #20?

#10 - large incisions
#11 - stabs
#12 - ENT/GYN
#15 - small incision
#20 -Digit amputations

104

What is the universal size for catheters?

16 french

105

When do indwelling catheters need to be changed?

Every 72 hours

106

What should you note in the medical record for a urine cath placement? (6)

Indication
Size/type
Fluid injected
Urine output
Your name
Complications

107

What drug needs to be in the syringe when doing an ABG?

heparin

108

What are the pertinent findings in an ABG? (6)

pH
PaCO2
PaO2
HCO3
O2
BE

109

Are you oxygenating the patient, or ventilating them when performing a cricothyrotomy?

Oxygenating them

110

In a needle cricothyroidotomy, what type of needle should be used?

#12 or #14

111

In a needle cricothyroidotomy, how many seconds do you oxygenate the patient by the tubing?

Occlude 1 second and release for 4

112

How long can chest tubes stay in?

24-48 hours

113

How can you check for air leaks in a chest tube?

Look at water seal chamber and if bubbles present = air leak

114

When do you see tidaling with a chest tube placement?

When pleuravac is taken off suction; fluid in chamber should move with respiration and ventilation

115

When should you obtain x-rays with a chest tube placement?

Beforehand, after insertion, serial during stay, and after pull out

116

What is the purpose of undermining tissue?

Undermining = separation of superficial tissues (epidermis/dermis) from deeper tissues (SC tissue) in order to achieve better tissue approximation during suturing

117

What is the most common cause of post-op fever? treatment?

Atelectasis
Spirometry

118

What are the 5 W's of post surgical infection?

Wind (atelectasis)
Water (UTIs)
Walking (DVTs)
Wounds (duh)
Wonder drugs (rxn)

119

What is the daily requirement for K?

40-100 mEq